Pharynx & Larynx Flashcards
Describe the etiology/risk factors of acute viral pharyngitis
- most common PC visit
- EBV, mpox, rhinovirus, coronavirus, influenza, adenovirus
- common in children, those in close contact
Describe the clinical presentation of influenza related acute viral pharyngitis
- cough
- myalgia
- headache
- fever
- “hit by a truck”
Describe the clinical presentation of EBV related acute viral pharyngitis
- persistent fatigue
- possible hepato/splenomegaly
- tender posterior cervical nodes
Describe the clinical presentation of HSV related acute viral pharyngitis
- vesicles
- shallow ulcers
- diffuse on palate
Describe the clinical presentation of adenovirus related acute viral pharyngitis
- conjunctivitis
- preauricular LAD
What are the bacterial causes of pharyngitis
- GABH
- strep
- gonorrhea
- diphtheria
- mycoplasma
- cornybacterium diphtheria
Describe the PE and diagnostic testing for acute viral pharyngitis
- always include abdominal exam
- +/- tonsillar exudates
- cervical LAD not typically prominent or tender
- negative RST/confirmatory test
- heterophile Ab
- flu test
Describe the treatment for acute viral pharyngitis
Usually self limited or supportive treatment
- antivirals with flu to shorten the course/lessen the symptoms (Tamiflu, baloxavir)
Describe the etiology/risk factors for mononucleosis
- EBV aka HHV-4
- saliva or close personal contact
Describe the clinical presentation of mononucleosis
persistent (1-2 mos) malaise, fatigue, HA, fever, sore throat
- milder forms can go undiagnosed
Describe the PE/diagnostic testing for mononucleosis
- exudative tonsils
- hepatosplenomegaly
- posterior cervical lymphadenopathy
- palatal petechiae
- axillary, inguinal, generalized LAD
- IgM heterophile Ab seen in 2nd week
- EBV specific Ab testing
- CBC w/ diff shows lymphocytosis
- peripheral smear shows atypical lymphocytes
Describe the treatment for mononucleosis
- treat symptoms: analgesics, corticosteroids for 4+ painful tonsils
- may have secondary strep
- avoid strenuous activity x21 days d/t risk of splenic rupture
- rare risk of CNS infection
What happens if PCN/ampicillin is given in mononucleosis
rash
Describe the clinical presentation of bacterial pharyngitis
Worse in adults
- sore throat
- odynophagia
- rever
- HA
- scarlatina rash (scarlet fever)
- kids may have dysphagia, irritability, n/v
- cough/rhinorrhea absent
- fever >100.4
- beefy red tonsils/oropharynx with exudates
- tonsillar hypertrophy/edema
- halitosis
- tender anterior cervical nodes
- strawberry tongue
Describe the diagnostic criteria for bacterial pharyngitis
GABHS Centor Criteria
- fever >100.4
- tender anterior cervical adenopathy
- no cough
- pharyngotonsillar exudates
Describe the diagnostic testing for bacterial pharyngitis
- **RST
- POCT**
- relfex to culture or PCR if RST neg
Describe the treatment for bacterial pharyngitis
- treat symptoms
- Amoxicillin or PCN VK PO BID x10 days
- cephalexin, azithromycin, clindamycin, PCN G IM x1
- **peds dosing: 50mg/kg/day divided BID x10 days
- 50mg/kg once daily
- max dose 1,000mg/day**
Describe the etiology/risk factors for rheumatic fever
can develop 1-5 weeks after strep infection
Describe the clinical criteria/presentation for rheumatic fever
Major
- J: joints (polyarthritis, hot/swollen)
- <3: heart (carditis, valve damage)
- N: Nodules (subq, extensor surfaces)
- E: Erythema marginatum (painless rash)
- S: Sydenham chorea (flinching movement disorder)
Minor
- P: Previous rheumatic fever
- E: ECG with PR prolongation
- A: Arthralgias
- C: CRP/ESR elevated
- E: elevated temp
Describe the diagnostic testing for rheumatic fever
- ECG with PR prolongation
- elevated ESR/CRP
- history of recent strep infection with presence of 2 major criteria or 1 major and 2 minor critera
Describe the etiology/risk factors for peritonsillar abscess
- can develop after strep infection (or staph)
- MC in adolescents/young adults
- usually unilateral
Describe the clinical presentation of peritonsillar abscess
gradually progressive: severe sore throat, dysphagia, fever, trismus, hot potato voice, fever
Describe the diagnostic testing/PE for peritonsillar abscess
- medial displacement of tonsil
- lateral displacement of uvula
- purulent abscess
- dehydration
- needle aspiration or I&D
Describe the treatment of peritonsillar abscess
- admit to hosp
- IV abx and hydration
- close follow up a day later d/t recurrence risk
Describe the etiology/risk factors of retropharyngeal abscess
- kids 0-6
- trauma/sharp object, post-pharyngitis, sinusitis, otitis
Describe the clinical presentation of retropharyngeal abscess
- trismus
- sore throat
- dysphagia
- stiff/swollen neck
- fever
- resp distress
- muffled voice
- drooling
Describe the diagnostic testing for retropharyngeal abscess
CT with contrast
Describe the treatment for retropharyngeal abscess
- airway management
- admit to hosp
- empiric broad spectrum IV abx
- serial CT
- +/- surgical I&D
Describe the etiology of sialadenitis
acute chronic recurrent inflammation of salivary gland (usually parotid) from infection, obstruction, or autoimmune cause (sjogren’s)
Describe the clinical presentation of sialadenitis
- fever
- pain when eating
- facial swelling
- difficulty swallowing
- dry mouth
- fever, swelling, TTP on PE
Describe the treatment for sialadenitis
- hydration
- NSAIDs
- gland massage
- warm compress
- sialogogues (lemodrops/popsicles)
Describe the etiology of mumps
- paramyxovirus
- trasmitted through saliva
- less common now with MMR vax
Describe the clinical presentation of mumps
- unilateral/bilateral swollen, painful salivary glands
- constitutional sxs
- orchitis: testicular swelling, infertility
Describe the etiology/risk factors for herpetic gingivostomatitis
- initial HSV-1 infection resulting in inflammation of gingiva and oral mucosa anywhere throughout oropharynx
- RF: <3 y/o, primary exposure, adult family with cold sore
Describe the clinical presentation of herpetic gingivostomatitis
- fever 1-2 days prior
- pain
- dysphagia
- perioral vesicular lesions
- shallow ulcerative enanthem
- irritability
- red gums that bleed easily
- drooling
- submandibular LAD
Describe the diagnostic testing for herpetic gingivostomatitis
can swab and PCR assay/cell culture to confirm
Describe the treatment of herpetic gingivostomatitis
- spontaneous resolution in 1-2 weeks
- topical liquid benadryl or antacid
- analgesics
- acyclovir
- hydration
What are some complications of herpetic gingivostomatitis
herpes simplex keratitis (eye), dehydration, encephalitis, recurrence as cold sores
- most contagious when vesicles/ulcers are present
Describe the etiology/risk factors for aphthous ulcers
aka canker sore
- small ulcers
- likely due to stress, hormones, trauma
Describe the treatment for aphthous ulcers
topical steroids, lidocain, heal in appx 10 days
Describe the etiology/risk factors for herpangina
- coxsackie virus, enterovirus, hand foot and mouth
- most spread in summer and fall
- respiratory, oral/fecal, fomite transmission
Describe the clinical presentation of herpangina
- small gray spots/shallow ulcers in oropharynx
- sudden onset of prodromal fever, sore throat, HA, dysphagia
- vesicles/ulcers on posterior oropharynx, tonsillar pillars, soft palate, uvula, tongue
Describe the treatment for herpangina
- no antivirals
- supportive, infection control
- spontaneously resolves in 7-10 days
Describe the etiology/risk factors for hand foot and mouth disease
- coxackieviruses
- RF kids in daycare, summer and fall
Describe the clinical presentation of hand foot and mouth disease
- fever, sore throat, malaise, dysphagia, irritability
- painful red blister-like lesions on anterior tongue, gums, inside cheeks, mouth
- red rash on palms, soles, diaper area
Describe the treatment for hand foot and mouth disease
- supportive, infection control
- spontaneous resolution in 7-10 days
Describe some complications of hand foot and mouth disease
- dehydration
- viral meningitis
- encephalitis
- skin may peel and nails fall off
Describe the clinical presentation of oral thrush
white patches in mouth that easily scrape off and may reveal raw red skin
Describe the etiology/risk factors of croup
laryngotracheitis
- inflammation of larynx and trachea
- marked swelling in subglottic area
- barky cough
- MC parainfluenza, RSV, adenovirus
Describe the clinical presentation of croup
- prodrome of nasal congestion/coryza
- fever, stridor, barking cough, hoarseness, breathing retractions
- stridor at rest = concerning
Describe the diagnostic testing for croup
labs imaging not typical
- x-ray may show steeple sign (epiglottic narrowing)
Describe the treatment for croup
Mild: manage at home with humid or cold air, antipyretics, oral fluids
Mod-Severe: dexamethasone, nebulized epinephrine, O2, IV fluids PRN
Describe the etiology/risk factors of epiglottitis
Life threatening emergency
- rapidly progressing cellulitis of epiglottis & surrounding structures leading to progressive obstruction
- bacterial: h flu, s aureus, GABHS, strep pneum
Describe the clinical presentation of epiglottitis
- fever
- severe sore throat
- drooling
- respiratory distress/stridor
- hot potato voice
- rapid onset an dprogression
Describe the diagnostic testing for epiglottitis
DO NOT do laryngoscopy - spasm and compromise
- cherry red epiglottis seen in OR during airway establishment
- thumbprint sign seen on x-ray d/t enlarged epiglottis
Describe the treatment for epiglottitis
Ambulance to ER
- +/- tracheostomy
- keep the patient calm
- IV abx
- consult ID for unvax household contacts
- HiB vax reducing incidence
Describe the etiology/risk factors for laryngitis
inflammation of larynx
- acute: viral (rhino, flu, adeno, coxackie), bacterial (GABHS, m cat), vocal strain
- chronic: irritants, GERD, malignancy, sinusitis, TB, candida
- chronic if 3+ weeks
Describe the clinical presentation of laryngitis
- dysphonia
- hoarseness
- coryza
- URI sxs
Describe what is seen on PE in acute laryngitis
- diffuse erythema
- edema
- vascular engorgement of vocal cords
Describe what is seen on PE in chronic laryngitis
- thickening
- mucus
- edema of vocal folds/lining
Describe the treatment for acute vs chronic laryngitis
Acute: reassurance, rest, humidification, hydration, salt water
Chronic: treat underlying cause, refer to ENT PRN, hydration, humidification, smoking cessation
Describe the etiology/risk factors of nodules vs polyps
Nodules: benign, chronic hoarseness in kids from vocal use, irritation in adults, bilateral
Polyps: chronic irritation in adults, unilateral, smoking, reflux, trauma
Describe the treatment for nodules vs polyps
Nodules: resolves in 3-6 mos in kids, nonsurgical in adults
Polyps: surgical in adults
